Healthcare Provider Details

I. General information

NPI: 1356371561
Provider Name (Legal Business Name): TRI STATE LUNG & SLEEP ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16218 SAINT CLAIR AVE
EAST LIVERPOOL OH
43920-9449
US

IV. Provider business mailing address

16218 SAINT CLAIR AVENUE
EAST LIVERPOOL OH
43920-0076
US

V. Phone/Fax

Practice location:
  • Phone: 330-382-9355
  • Fax: 330-382-9448
Mailing address:
  • Phone: 330-382-9355
  • Fax: 330-382-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberOH35-07-9747A
License Number StateOH

VIII. Authorized Official

Name: GHULAM R AZIZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-382-9355